Nicotine replacement therapy

Nicotine replacement therapy to some extent it replaces the nicotine that a person gets from smoking. The dose depends on the amount, intensity and habit of smoking. NICE (2018) recommends a long-acting product (e.g., a patch) and a short-acting product with a wide range; they provide a dose of nicotine to help with passions. Most are absorbed sublingually (e.g., vaping, chewing gum, spray, or inhaler). The dose is usually reduced to 12 weeks, but heavy smokers may need a longer period.

Electronic Nicotine Delivery Devices (ENDDs), including e-cigarettes.

ENDDs are electronic devices that mimic and emit cigarettes and are commonly known as vaping or e-cigarettes. There are hundreds of different types of devices and juices. The legal regulation started in 2016 and has two types:

Consumer products: Manufacturers will have to register their products, there are standards to be followed, and advertising is restricted.

Licensed products: Manufacturers can apply for a drug license, which can then allow them to write a prescription and advertise. To date (2019) there is no licensed device manufactured.

A common question is whether e-cigarettes are recommended by health professionals. Public Health England (2016) published a report showing that smoking carries some of the risk, but not risk-free. However, if a person smokes, we know that their risk of dying from a smoking-related illness is at least 50%, often in middle age. Public Health England (2019) has published an update on the evidence reviewed by leading independent tobacco experts. See: Smoking in the UK: Evidence update in February 2019.

The evidence base is still evolving and there is a lot of controversy for and against e-cigarettes, but there are some excellent resources that are updated as new evidence emerges, see E-cigarettes: A Briefing for Smoking Cessation Services.

Some people will switch to e-cigarettes and stop using tobacco, while others may use e-cigarettes to quit smoking. Some may use both tobacco and e-cigarettes, depending on the circumstances, and this is called “dual use.” We need to encourage everyone, and especially those who “quit”, to apply to local smoking cessation services to help them quit. Behavioral support in addition to using e-cigarettes can and should be offered to increase their chances of quitting.

RCN is a member of the All-Party Parliamentary Group on Smoking and Health (APPG) and supports lobbying for guidance and support on e-cigarettes and how they can be best used to help quit smoking. See Government regulations and guidelines on e-cigarettes and cigarettes. See also RCN policy briefing: Revision of European legislation on the Tobacco Products Directive. RCN Declaration of Position (2013). Report to All Party Parliamentary Groups in the UK summarized the evidence on the main problems associated with e-cigarettes.

The European Union and its Member States have taken various measures to combat tobacco in the form of legislation, recommendations and information campaigns. Tobacco consumption is the biggest preventable health risk in the European Union. It is the leading cause of premature death, responsible for about 700,000 deaths each year. About 50 percent of smokers die prematurely, an average of 14 years ago.

Pregnancy Smoking Call Group has published a new document: Using e-cigarettes during pregnancy: A guide for midwives and other health professionals. The purpose of the briefing is to provide a summary of the evidence on e-cigarettes and suggested answers to some frequently asked questions about their use during pregnancy. Public Health England also published a blog: Achieving a Non-Smoking Pregnancy: Can E-Cigarettes Help? See also: RCN Obstetrics Forum.

Cancer Research There are some useful documents and briefings to date on the role of e-cigarettes in the UK, their safety, effects and role in smoking cessation.

The Royal Society for the Prevention of Accidents (ROSPA) has developed guidelines for smoking at home. There is also a good blog on safety advice for parents and families from Joe Locker, Tobacco Control Manager, UK Public Health Manager, see: Smoking at Home: Tips for Parents.

Prescription drugs

Vareniklin (Champix) It is a partial agonist that prevents nicotine from reaching the receptors, and also releases dopamine to help with passions. The dose is titrated, ie a person smokes for 8-14 days before quitting. The course of oral tablets is usually 12 weeks.

Bupropion (Zyban) is an old drug that is not often used now. Its main use was as an antidepressant, and oral tablets were found to have beneficial side effects that help quit smoking. A course usually lasts 8-12 weeks.

Count each connection

Increasing the number of each contact is an approach that uses the millions of contacts that health professionals and organizations need to support them with positive changes for their physical, mental health and well-being. This is the responsibility of all health workers, and nurses and midwives must ensure that they have the skills to master this approach.

This includes asking about lifestyle, giving brief advice, and then referring to a service or individual who can provide more in-depth intervention. It is also called the Short Intervention Advice and is summarized as follows:

What to do

The National Center for Smoking Cessation and Training (NCSCT) has developed a short training module to provide Very Short Smoking Advice. The training module is based on evidence-based behavioral change methods that provide an understanding of the factors involved in smoking cessation and smoking cessation. It has been shown that the training program increases the knowledge of the trainees, develops their skills and leads to improved experience.

Behavioral change methods within the NCSCTs Very Brief Advice (VBA) are:

ASK – All patients who smoke

ADVICE – The best way to stop

ACT – Provide a referral or offer behavioral support and medication